Consent To Application Of Tattoo / Release And Waiver Of All Claims

I acknowledge that I am not pregnant and that I am free of communicable diseases. *

I Agree

I acknowledge that I am not under the influence of any drugs or alcohol. *

I Agree

I acknowledge that I have truthfully represented to HipLLC that I am over 18 years old, or I am over 16 years old and my parental guardian is present with me in this process. *

I Agree

I acknowledge that it is not reasonably possible for HipLLC to determine whether I might have an allergic reaction to the dyes, pigments, jewelry or processes used in my modification, and I agree to accept the fact that such a risk is possible. *

I Agree

I acknowledge that infection is always possible as a result of the obtaining of any modification, particularly in the event that I do not take proper care of my modification. *

I Agree

I acknowledge receipt of verbal or written instructions advising me of the proper care of my modification and I recognize the absolute necessity for following those instructions. *

I Agree

I acknowledge that a modification is a permanent change to my appearance and that no representation has been made to me as to the ability to restore my body to its original state. *

I Agree

I acknowledge that the obtaining of my modification is by my choice alone and I consent to the application of the modification and to any actions or conduct by HipLLC reasonably necessary to perform the procedure. *

I Agree

I agree to release and forever discharge and hold harmless HipLLC of any and all claims, damages, or problems I may have there after receiving my modification. *

I Agree

I hereby give HipLLC the rights to do as they wish with pictures that may be taken of the modification I am receiving. *

I Agree

I understand that variations in color and design may exist between any tattoos as selected by me and as ultimately applied to my body. If my tattoo is a symbol or something written in English or any other language the representatives and the owner of this business are not responsible for what it may or may not contain. *

I Agree

I do also understand that after I leave HipLLC the modification is my responsibility. *

I Agree

Name (This Doubles As Electronic Signature) *

First Name

Last Name

Date Of Birth *

MM

DD

YYYY

Phone *

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Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country